Children had long wait times for appointments for initial assessment in behavioral health clinics in San Bernardino. It was brought to my attention when I had a family member who needed services quickly. There were efficient teams, but they were overwhelmed with the adult population, substance use disorder recovery services, and other programs within the clinic. I was not sure how to address this until I did those interviews with other stakeholders and realized there was an opportunity to build a children’s wellness center separate from our regular behavioral health clinics.
Imagine an under-resourced place in East San Jose where Vietnamese immigrants live with significant health and social disparities. The community is painfully aware that due to legacy of war, political persecution, and mass displacement, they have been through significant multigenerational trauma. They prioritized and advocated for the building of a trusted place where they can receive mental health services in their own language or through an interpreter that they trust.
Nationwide, Black patients who are admitted to the hospital experience disparities in pain management, patient communication, length of stay, and readmission rates. This disparity is seen at UCSF Health, where black inpatients have lower patient communication scores, higher lengths of stay in the hospital, and higher readmission rates than the rest of the patient population. In addition, there is limited engagement and input from community members in the care that hospitalized patients receive at UCSF Health.
The City of Compton, California and community of North Long Beach, California continue to experience extraordinary barriers to lifesaving medical care. With the highest rates of maternal mortality, infant mortality, and homicide in Los Angeles County, these areas lack essential lifesaving medical services including, a high-risk hospital-based birthing center, a neonatal intensive care unit, and a level-one trauma center.
My initial point of inquiry was to better understand what we mean by “equity” and how to operationalize it. In June 2020, employees throughout San Mateo County Health walked out to collectively grieve the murder of George Floyd by police and publicly commit to dismantling the structural racism within our health care system. But what would this look like? How could we translate broad statements into actual wellbeing for our communities? For me, we needed to start by asking our patients and communities these questions and collaborating to implement solutions.
When thinking about organizational excellence within a health care organization, clinical efficiency and quality patient care immediately come to mind. Physicians and nurses who provide direct patient care take center stage. What about the radiology and lab staff whose images and test results ensure appropriate diagnoses? What about the schedulers that support patient access, the housekeepers that keep the environment clean for safe patient care, and the facilities management tradesmen who work to keep the lights on?
Often, education of our hospitalized patients occurs in the last few hours of their stay. And there are no standards for how to perform this critical work. This project was inspired by my Spanish-speaking patient, Jose. Jose was re-admitted to our hospital with cirrhosis and volume overload, a new diagnosis that was made just a few months prior to when I cared for him. In exploring what happened, he barely recognized the term “cirrhosis” let alone Lasix and the other medications that were prescribed to control his symptoms.
Medicaid patients remain in acute care settings (acute hospitals, long term acute care hospitals, skilled nursing facilities) because there are no safe, clinically appropriate discharge options. This results in an increased number of administrative or denied days because the patients are no longer clinically acute and are just awaiting placement. Patients who could be in an inpatient bed or in a skilled nursing facility are instead stuck boarding in the emergency department or an inpatient bed.
The advancement of Health Equity, including the identification of outcome gaps and the development of processes to close those gaps, has become a major focus for the Centers for Medicare and Medicaid Services as well for managed commercial insurance plans. This project was designed to identify the most significant and urgent Health Equity opportunity within a county hospital and to create a pilot intervention to close high priority identified gaps.
am Director of Women’s Health for Eisner Health, an FQHC which provides physician and midwife care to 2000 birthing people annually at two safety net hospitals in Los Angeles. Local, statewide, and national data all show significant health disparities around maternal morbidity. The majority of maternal morbidity is secondary to the need for transfusion. Women who present to labor and delivery anemic are more likely to need transfusion.